DM Part 6

Question 1

What is a basal bolus regimen?

Answer 1

• Bolus: rapid or short acting insulin before meals
• Basal: intermediate or long acting insulin once or twice a day
• this most closely mimics endogenous insulin production
• goal: to achieve a glucose level of 80 to 130 mg/dL before meals

Question 2

Explain mealtime Insulin Bolus?

Answer 2

• Rapid acting: mimics natural insulin in response to meals. (lispro, aspart, glulisine). Injected within 15 minutes of mealtime because onset is 5-15 minutes. This mimics the natural insulin in response to meals.
• Short acting regular Bolus: onset of action is 30 to 60 minutes and it is injected 30 to 45 minutes before a meal.

Question 3

What insulin is likely to cause hypoglycemia and why?

Answer 3

-short acting because of a longer duration of action (4 to 6 hours)

Question 4

In critical situations like DKA what is the only insulin that can be given IV?

Answer 4

Short acting: regular (Humulin R, Novolin R, Iletin II regular)

Question 5

What is basal background insulin?

Answer 5

-intermediate-acting insulin:
NPH, duration is 12 to 18 hours, peak is 4 to 12 hours (this peak can result in hypoglycemia)
-NPH can be mixed with short and rapid acting insulins
-cloudy (NPH) must agitate to mix
-Long acting (basal): (glargine (lantus, Toujeo, Basaglar) and detemir (Levemir), Degludec (Tresiba)
-released steadily and continuously with no peak and onset varies
-administer once or twice a day
-do not mix with any other insulin

Question 6

Can long acting insulin be mixed with any other insulin?

Answer 6

No

Question 7

What insulins can be mixed?

Answer 7

intermediate can be mixed with short or rapid acting

Question 8

What does mixing intermediate with short or rapid acting coverage for?

Answer 8

mealtime and basal coverage in one injection

Question 9

Explain the storage of insulin?

Answer 9

-do not heat or freeze
-in use vials/pens may be left at room temp up to 4 weeks
-refrigerate extra unopened insulin
-avoid direct sun, extreme heat or cold
-prefilled can be stored upright for 1 week
for 2 insulin types and 30 days for one insulin type
-roll before prefilled before use

Question 10

Why cant insulin be taken orally?

What type of insulin can be given IV?

Answer 10

• insulin is inactivated by gastric juices

- regular may be given IV

Question 11

What is the fastest to slowest absorption sites?

Should a site that is going to be exercised be injected and why?

Answer 11

• abdomen, arm, thigh, hips
• a site that is going to be exercised should not be injected into because it increases the rate of insulin absorption and speeds the onset of action resulting in hypoglycemia

Question 12

Explain rotation of site.

Answer 12

-rotate between sites and at least 1.5 to 1 inch away from previous site

Question 13

What are the unit increments for a 0.3 and 0.5 mL syringe (50 U syringe)
and for a 1mL or 100 U syringe?

Answer 13

• 1 U increments for the 0.3 to 0.5 mL

- 2 U increments for the 1 mL syringe

Question 14

Who is the only person who can recap a syringe? How should the site be cleaned before injection?

Answer 14

• a self injector

- at home soap and water is fine, otherwise follow hospital policy

Question 15

What is a good option for injection if a person has decreased vision?

Answer 15

insulin pen

Question 16

What type of insulin is used with a pump?

How often should the set and site be changed?

Answer 16

• continuous subcutaneous infusion or rapid-acting insulin

- set and site should be changed every 2 to 3 days